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Abstract:
Traumatic/surgical brain injury can initiate a cascade of pathological changes that result, in the long run, in severe damage of brain parenchyma and encephalopathy. Excessive scarring can also interfere with brain function and the glial scar formed may hamper the restoration of damaged brain neural pathways. In this preliminary study we aimed to investigate the effect of dressing with an L-lactide-caprolactone copolymer nanofiber net on brain wound healing and the fate of the formed glial scar. Our rat model of surgical brain injury (SBI) of the fronto-temporal region of the sensorimotor cortex imitates well the respective human neurosurgery situation. Brains derived from SBI rats with net-undressed wound showed massive neurodegeneration, entry of systemic inflammatory cells into the brain parenchyma and the astrogliosis due to massive glial scar formation. Dressing of the wound with the nanofiber net delayed and reduced the destructive phenomena. We observed also a reduction in the scar thickness. The observed modification of local inflammation and cicatrization suggest that nanofiber nets could be useful in human neurosurgery.

Keywords:
brain injury, L-lactide-caprolactone copolymer nanofiber net, glial scar, neurodegeneration

Abstract:
Excessive cicatrisation or epidural fibrosis in the operative field is an inappropriate event occasionally occurring after neurosurgical procedures (i.e., spine procedures and craniotomies). This excessive process may disturb the postopera­tive course and render reoperations more difficult and risky. The literature describes this phenomenon as accompanying up to 20% of neurosurgical procedures. The scar tissue that forms postoperatively adheres to the dura mater, penetrates into the spinal canal and can cause narrowing symptoms, neurological deficits and pain. The incidence and spread of this excessive scar or epidural fibrosis can be prevented through the modification of the surgical technique by incorporating endoscopic or microscopic access to minimize the operative field and the use of isolating substances (autogenous or heterogeneous) administered intraoperatively.

The aim of this experimental study was to morphologically assess the cicatrisation process, adhesion and to prevent excessive scar formation with the local use of membranes manufactured by an electrospinning process (nanotechnology). We also investigated whether the biodegradable nanofibrous net triggers or modifies the immunological response or the local inflammatory process.

Micro-nanofibrous membranes were produced by the electrospinning process. A biodegradable, medically certified copolymer poly(L-lactide-co-caprolactone) (PLCL) was used as the electrospun material.

An experimental rat model was used in this study. Experimental and control groups were formed with specified follow-up times of 4, 14 and 30 days. During the operation, a two-level laminectomy in the thoracic segment was performed. The operative field was divided into two regions. Isolating material was used on the dura mater and surface of the spinal cord in the area where the laminectomy was performed. The material was analysed with the use of light and electron microscopy.

Local cicatrisation can be modified using nanomaterials. Scar formation and epidural fibrosis can be limited and modi­fied locally. No local inflammation process was observed.

Initial observations indicate the potential for the effective use of materials obtained in the electrospinning process to prevent cicatrisation.

Keywords:
neurosurgery, cicatrisation, epidural fibrosis, copolymer, poly(L-lactide-co-caprolactone), nanofibrous net, rat model

Abstract:
Electrospun nonwovens have recently been successfully applied as a dressing material in spinal neurosurgery. Scarring is known to be one of the major post-operative complications for neurosurgery. If it occurs, it may trap a nerve, so that when a patient moves the nerve becomes stretched, causing nerve damage, pain, and internal scarring of the nerve. This causes subsequent complications related to ingrowths of connective tissue onto the spinal canal. The formation of an astroglial scar is another serious postoperative complication of brain neuro-surgery. The use of bio-absorbable isolative materials as anti-liaison protection and as possible carriers for neuroprotective drug delivery is expected to help in solving such problems. The nanostructured material acts as an anti-bacterial and anti-liaison barrier while enabling transport of oxygen, nutrients, and metabolites, facilitating the healing process of the surgical wound.

Keywords:
Nanofibres for neurosurgery, protection of scar formation